Human growth
and development, with the requisite learning of skills and mastery of
cognitive and psychosocial tasks, unfolds in endlessly fascinating,
complex patterns. If the child is to develop a healthy personality,
then he or she must learn how to test reality, regulate impulses, stabilize
moods, integrate feelings and actions, focus attention, and plan.

When an attentional
problem is present, with the hallmark symptoms of distractibility,
hyperactivity/restlessness, and/or impulsivity, the child’s ability
to master some or many of these tasks will be more difficult. Complicating
the situation is the fact that many children with attentional problems
also have other learning problems.

The parental role
has always encompassed difficult periods when parents feel confused
and worried about how well they are fulfilling their responsibilities.
Raising a child with Attention Deficit Disorder can be exceedingly
frustrating, emotionally draining, and expensive.

In many instances,
the child’s ADD-related problems cause ongoing problems in the parent-child
relationship that can set the stage for an unhappy, guilt-ridden relationship
between the child, parents (and siblings) that may persist, sometimes
through life. The strain from raising these ‘difficult kids’ takes
a toll on many marriages, especially when parents differ in their
approach to the child.

Complicating the
family situation is the fact that Attention Deficit Disorder is often
genetically transmitted from one generation to the next. Thus, we
often find an ADD child being raised by an ADD parent who was never
diagnosed and who has a very limited understanding of why the child
is having problems (which may, incidentally, mirror problems that
the parent himself experienced as a child).

The Infant: Developing Trust

During
the first several months of life, the infant faces several critical
developmental tasks, including learning how to regulate and calm him/herself
and how to use the senses to learn about the world and the people in
it.

However, the most critical psycho-social task faced by the infant
relates to the development of trust; the infant must learn that his/her
needs will be reliably met by parents/caretakers. In developing trust,
the infant also learns that he/she is dependent on par ents/caretakers
to meet all needs — for food, warmth, safety, comfort — for survival.

The ability to
organize sensations and to feel tranquil may pose problems for babies
who are later diagnosed as having attentional deficits. These babies
are often described as "hyper-excitable", "colicky", "irritable",
and/or "unsoothable" by their parents.

These infants
are often very active, easily distracted, and over-reactive to stimuli.
Their behavior may appear to be chaotic or unpredictable. They
may also be extremely sensitive to sensations — visual, auditory or
tactile. Parents’ efforts to soothe these babies with words, songs,
or stroking may be met with tensed muscles, arching back, and loud
crying.

Not surprisingly,
parents often respond to a ‘difficult’ baby with confusion and alarm.
The inter-relationship between nurturing parent(s) and child is critical.
When parents have a child with whom they cannot cope, they usually
assume it is their "fault"— that they are failing as parents. These
feelings of failure can set the stage for problematic, guilt-laden
parent-child interactions that continue through life.

The Toddler: Tolerating Separation

The second
psychosocial developmental stage faced by the young child is that of
separation. The separation process occurs in gradual steps, occurring
from about nine months to three and a half years.

During this period,
the child develops the ability to hold a mental image of the parent
in his mind. He begins to explore and learn about his environment and
tolerates longer periods of separateness from significant parenting
figures. As the child accomplishes the task of separating, a strong
sense of autonomy and confidence develops.

The toddler is
also beginning to connect feelings and behavior. He is learning to
take the initiative to get his needs met. He is developing ideas and
concepts, along with awareness that objects have functions (i.e. cups
are to drink from, refrigerators hold food).

The youngster
is beginning to accept limits which helps him to learn what
he can and cannot do. As a correlate, he needs to learn to tolerate
frustration. Finally, he needs to learn how to recover from the stress
of disappointments and adapt to changes in his environment.

These developmental
tasks can present significant problems for children with attentional
deficits.

Typically, these youngsters have difficulty tolerating frustration
and may be emotionally over-reactive. Parents describe them as "all-or-nothing"
children who have difficulty calming themselves. They tend to "fall
apart" easily, dissolving into tears of frustration when needs or
wants are not met immediately.

The Pre-School Child: Individuation, Identity, and Self-Concept

"Who am
I?" asks the pre-school youngster, as s/he experiments with wildly different
roles and identities.

This child tends to be unpredictable, volatile,
and charmingly affectionate — while also learning to be disarmingly adept
at manipulating the environment and the significant others within it!
Children between the ages of three and six have a well-earned reputation
for learning how to "divide and conquer" to get their wants and needs
met.

Not surprisingly,
pre-school youngsters often have great difficulty distinguishing between
reality and fantasy. As they try on different identities (teacher,
policeman, father, mother), their ability to think magically is an
asset. Nothing is impossible when you are four or five!

As the child begins
to develop a solid identity, the self-concept is also emerging. Each
child’s self-concept consists of images and beliefs about the self,
including easily-verifiable facts ("I am a girl", "I have black hair")
and less-verifiable but strongly-held beliefs and image about the
self ("I am smart/dumb", "I am lovable/unlovable", "I am good/bad").

During the pre-school
years, the common behavioral signs exhibited by many children with
attentional deficits — high activity levels, poor persistence, interpersonal/peer
group problems, and difficulty modulating behavior and impulses, with
aggression, tantrums, silliness, bossiness, and impulsivity, are often
beginning to create problems for the youngster.

The child may be fearful,
confused, manipulative, or avoidant. Attention deficit and other learning
disabilities are strong contributors to the emergence of over-anxious
disorders of childhood, including school phobias.

Since a diagnosis
of Attention Deficit is usually not made until after the child
enters school, the atypical ways that these children react and respond
during the first years of life are perplexing and distressing to parents and other family members.

Confused parents often send strong
disapproving messages to the child that he can behave and stay under
control if he tries hard enough. Concerned family members often criticize
both child (for being bad) and parents (for being ineffective), creating
even more stress between parents and child.

The Elementary School Child: Consolidation Stage

As the
child shifts from pre-school to elementary school, he consolidates the
gains made during the previous stages (i.e., basic trust, separation,
and individuation). The major psychosocial tasks of childhood have been
dealt with, freeing the latency-aged child to focus his energy on learning
in school along with the development and refinement of interpersonal
relationships.

The school, as
the vehicle for teaching academics and social skills, now occupies
a central role in the child’s life. Vast amounts of factual data must
be learned. The child must learn how to read, write, do arithmetic,
be a good friend, and be a good student. The elementary aged youngster’s
tasks include learning how to relate appropriately to adults (aside
from parents) and children (who are not siblings).

After entering
the educational system, the child with attentional deficits often
begins to struggle. The child may lag behind his peers, academically
and socially.

ADD youngsters often have "social deficits" in that
they have difficulty accurately interpreting and processing social
information and cues. This "social deficit disorder," coupled with
impulsivity, may lead to the development of socially unacceptable
behaviors.

Paradoxically,
many children and adults with Attention Deficit Disorder are also
exquisitely sensitive to feedback from others. As the child becomes
aware of his differences from others, is shunned or teased by peers,
is criticized by teachers for being unable to remain in control, the
child begins to develop a negative self image, low self-esteem, depression
and anger.

What significant others (parents, teachers) tell the child
about himself has a powerful impact on his developing self-concept.
The child begins to view himself as he is viewed by others. Told repeatedly
that he "could do better if he would only try", he begins to feel
that "I am worthless because I cannot always control my behavior."
Sadly, these negative feelings about the self often persist through
life.

How to Help

Attention
Deficit Disorder is a neurobehavioral disorder that causes multiple
problems for children. Typically, the child with ADD will experience
difficulties in several areas of life, including learning, peer relationships,
self-esteem, mood, behavior, and family relationships.

Medication helps
to relieve many symptoms of distractibility and hyperactivity in about
75% of children. Most children are treated with psychostimulant medications
(Ritalin, Cylert, Dexedrine). Others respond to a carefully titrated
blend of antidepressant medication and/or psychostimulants. There are other medications which
are used less frequently but also with good effect.

Therapy or counseling
is useful in helping the child and family deal with ADD-related
problems. If therapy is indicated, it is important that parents select a professional
who is knowledgeable about ADD and its impact on both child and family.

Depending on the child’s problems, therapy may include a variety of
interventions, including social skills training, compliance training
with parents, psychosocial education of parents and child, anger management
training, cognitive therapy to improve self-esteem and mood, and family
therapy with parents and siblings.

Living with a child with ADD/ADHD can offer special charms and delights. These children
can be very perceptive and sensitive to the plight of others. They
are intensely curious, creative and inventive. Many are very affectionate.

Most of their ‘problems’ arise from the fact that they process emotional
and intellectual information somewhat differently from ‘normal’ children.
Our culture places great value on conformity, especially in the training
and education of children. If the child with ADD is raised and educated
with an appreciation of his or her uniqueness and strengths, then
that child can grow up into a healthy, productive adult.

NOTE: This article is
for information purposes only and is not to be substituted for medical
advice from the professional of your choice.